Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries

Maguire, Sabine; Hunter, Bruce; Hunter, Lindsay; Sibert, Jo Richard; Mann, Mala; Kemp, Alison Mary
December 2007
Archives of Disease in Childhood;Dec2007, Vol. 92 Issue 12, p1113
Academic Journal
Introduction: A torn labial frenum is widely regarded as pathognomonic of abuse. Methods: We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse. Nine studies documented abusive torn labial frena in 30 children and 27 were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury. Results: Two studies noted accidentally torn labial frena, both from intubation. Abusive intra-oral injuries were widely distributed to the lips, gums, tongue and palate and included fractures, intrusion and extraction of the dentition, bites and contusions. Conclusions: Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra-oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found.


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